Now would be a good time to wrap-up my long two months on my Internal Medicine clerkship, seeing as though I start Pediatrics tomorrow, which totally scares me because kids definitely don’t get my wry sense of humor and frequent pop culture references. In no particular, bullet order, because I’m just not in a paragraph writing mood tonight:

• After ranting for 20 minutes to my parents about how much I hated it, medicine turned out okay in the end, probably because I had a fun team and better attendings my second month. And okay, fine, I learned a lot, despite my best effort.
• No wonder people specialize. There’s just too much to freaking know.
• Man are we obsessed with data and risk and studies and evidence. Trial X found a Y% drop in Z when using Drug A dose B compared to Drug C dose D. This is the reason medical research and spending will always have a rationale. There will always be something a liiiittle bit better than the last breakthrough. Or sometimes studies suggest something reeaaaaally expensive for milllllions of patients. Are we really going to put pacemakers in everyone with heart failure?
• We spend an awful, awful lot of money on really, really sick patients, and often we spend huge sums of money on people in their last 6 months of life. In one study in LA, almost 50% of patients were seeing more than 10 doctors in their last 6 months of their lives. Is that how they really wanted to spend their time?
• Can someone please, please explain to me why nurses record a “normal” respiratory rate as 18 or 20? Because it’s not. It’s like 12-14.
• As a patient, don’t piss off your nurse, because if you’ve got an unprofessional one, he or she will turn all passive-aggressive. If this happens, tell your doctor; if nothing improves, go to the Patient Advocate.
• There is a nursing shortage in this country. If you need something as a patient, obviously ask for it, but try to be reasonable. A hospital is not a hotel. Try to make sure your loved ones are reasonable too. This will be help avoid the preceeding statement.
• As a patient, you will have better, more efficient medical care if you know the names of your medical problems and the names and dosages of your medications. A list is even better.
• Kate has been writing about medical malpractice and there’s been a lot of discussion about practicing defensive medicine, and their associated costs, but I would not be surprised if a large amount of spending is also devoted to repeating tests that have been done at one hospital but are not available at another. This is INSANE. I can now pay people money with my cellphone , but I can’t see images or lab values from a hospital 5 minutes away? You’ve got to be kidding me.
• For people that take multiple medications, automatically assume that they forget to take them. Ask: “How often do you miss taking these?” It will make patients feel less worried about trying to please the doctor.
• Trying to please the doctor is a normal human reaction. It’s why you brush your teeth extra well and floss before you go to the dentist. Just be honest, that’s the most important thing.
• I will never ever ever be an oncologist. They save so many people that they think everyone can be saved, and often lose sight of the fact that everyone dies. I don’t know how often patients were encouraged to undergo another round of chemo when it was obvious to everyone else they didn’t have much time to live. Then again, hindsight’s 20/20.
• Giving people a comfortable, safe, and supportive place to die is one of the most compassionate things one can do for another.
• The surgeon’s 30-day mortality statistic can lead to some pretty perverse incentives to keep patients alive.
• Many of the problems in modern medicine, like most other areas of life, are due to laziness. As my surgery resident told me: “You’ve got. To do. Your job.”
• There was a NYT article last week talking about how doctors are on such a different playing field from their patients that they seem like they’re from a different planet. I would have to agree.
• I came in thinking the differential was kind of silly, like that more cases than not are cut and dry. I now know why doctors are so damn skeptical and suspicious and often agnostic or atheistic. They’ve been burned too many times assuming one thing when it turns out to be something else entirely, or have been sure about a diagnosis, and then they find that they’re wrong.
• You really do need to understand the physiology to understand the pathophysiology to figure out the treatment. This makes it hard for me to believe in new agey healing stuff.
• Want to know why doctors are so unhealthy? Because we spend so much freaking time taking care of patients that we eat crappy food at the hospital and don’t have time to get to the gym. Also, because we are hypocrites. Or at least, that’s my excuse. Feel free to use it if you like. I seriously should go ahead and start a thiazide and a statin.
• Interns get freaking worked . I am trying to vigorously avoid this from happening, and am hence taking a year off to do “research.”
• More bullets to come.

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